SP240PREDICTORS OF THE DEVELOPMENT OF ACUTE KIDNEY INJURY IN DENGUE VIRAL INFECTION; A RETROSPECTIVE STUDY

Abstract

Introduction and Aims: Acute Kidney Injury (AKI) is a neglected complication of dengue viral infection (DVI) leading to mortality and increased hospitalization. Determination of predictors causing AKI can reduce number of fatal cases and days of hospitalization among DVI patients. The aim of current study is to investigate predictors of AKI among DVI patients. Method(s): A retrospective study was performed with 257 patients in tertiary care hospital. Patient's demographics and laboratory findings were extracted by using hospital database. All the information was collected on pre-designed and approved data collection form. Result(s): Out of 257 (mean age: 38.6 +/- 11.4 years, male: 174) patients, AKI was found in 29 (11.3%) patients according to Acute Kidney Injury Network (AKIN) of classification. All the patients were divided into study group (AKI) and control group (non-AKI). Significant differences were observed in certain laboratory parameters between two groups. Univariate regression model revealed old age [HR (hazards ratio): 4.1, P = 0.007], male gender (HR: 2.7, P < 0.001), transaminitis (HR: 5.8, P < 0.001), urinary sedimentations (HR: 1.9, P < 0.031), elevated blood urea nitrogen (HR: 6.2, P < 0.003), rhabdomyolosis (HR: 7.2, P < 0.001), multiple organ failure (HR: 4.6, P < 0.022) and thick gall bladder (HR: 6.6, P < 0.041) were significant predictors of AKI among DVI patients. All the significant predictors in univariate model were subjected to multivariate regression model that revealed male gender (HR: 2.2, P = 0.013), transaminitis (HR: 1.1, P < 0.027), rhabdomyolosis (HR: 11.3, P < 0.001), multiple organ failure (HR: 19.4, P < 0.014) and elevated blood urea nitrogen (HR: 7.3, P < 0.041) as significant predictors of development of AKI in DVI patients. Male gender and thick gall bladder failed to demonstrate any prediction for the development of AKI in multivariate analysis. Among urinary sedimentations, proteinuria was found significant (HR: 2.5, P = 0.014) predictor of AKI in DVI patients. Increased hospitalization was observed in study group as compared to control (4.6 +/- 1.2 days vs 3.3 +/- 0.9 respectively, P < 0.05). All the three fatal cases had AKI. Conclusion(s): Dengue associated AKI is rare but fatal intricacy causing burden to health care system in terms of mortality, increased bed occupancy and medical cost. Timely recognition of patients having risk factors (predictors) of AKI can reduce mortality and morbidity associated with dengue induced acute kidney injury.